ChemInform Research Articles

Paediatric nutritional care after hospital discharge: A systematic review

Paediatric nutritional care after hospital discharge: A systematic review

Recycled Low Density Polyethylene Reinforced with Deverra tortuosa Vegetable Fibers

In this work, natural fibers extracted from the medicinal aromatic plant Deverra tortuosa, with different sizes (S1 = 2 mm and S2 = 500 μm), were incorporated into recycled low density polyethylene (rLDPE) to produce sustainable biocomposites. Compounding was performed with different fiber concentrations (0 to 30% wt.) via twin-screw extrusion followed by injection molding. Based on the samples obtained, a comprehensive series of characterization was conducted, encompassing morphological and mechanical (flexural, tensile, hardness, and impact) properties. Additionally, thermal properties were assessed via differential scanning calorimetry (DSC), while Fourier transform infrared spectroscopy (FTIR) was used to elucidate potential chemical interactions and changes with processing. Across the range of conditions investigated, substantial improvements were observed in the rLDPE properties, in particular for the tensile modulus (23% for S1 and 104% for S2), flexural modulus (47% for S1 and 61% for S2), and flexural strength (31% for S1 and 65% for S2). Nevertheless, the tensile strength decreased (15% for S1 and 46% for S2) due to poor fiber–matrix interfacial adhesion. These preliminary results can be used for further development in sustainable packaging materials.

Study finds association between levonorgestrel exposure, depression

A cohort study based on national data in Denmark has found a dose‐dependent association between use of levonorgestrel‐releasing intrauterine systems (LNG‐IUSs) for contraception and risk of incident depression. The study's investigators pointed out that the 1‐year absolute risks of depression in users of LNG‐IUSs were relatively small. Study results were published online July 10, 2024 in the American Journal of Psychiatry.

Validation of a laser visual feedback and core stability exercise programme to improve lateropulsion reduction and pushing intensity in stroke patients with pusher syndrome: A Delphi study.

The patient with pusher syndrome (PS) is characterized by showing postural control alterations due to a lack of perception of his own body in the space. It appears when the patient actively pushes with his unaffected limbs towards the injured side, reacting with resistance to passive straightening towards the midline. Between 10% and 50% of strokes present PS. Nowadays, there is no clearly defined treatment for PS. To design and validate an exercise program using visual feedback and specific core stability exercises (FeViCoS) for the treatment of patients with PS. Validation was conducted by expert consensus using the Delphi method. Thirteen neurorehabilitation experts participated in the process. An online questionnaire with 18 Likert-type questions was used to evaluate the designed program. Consensus was considered reached if there was convergence between the quartile 1 and 3 values (RIQ=Q1-Q3) or if the relative interquartile range (RIR) was less than 20%. The degree of agreement between experts was measured by calculating the Fleiss' kappa coefficient. A total of 2 rounds were required to achieve 97.44% consensus with 100% participation. The RIR was less than or equal to 20% for all questions. The Fleiss' kappa index (0.831) showed that the degree of agreement between experts was excellent. Neurorehabilitation experts considered FeViCoS valid for the therapeutic approach to patients with PS. Expert consensus suggests a novel strategy in physical therapy clinical practice to improve balance and postural orientation in patients with subacute stroke and PS.

Wildfire exposures and in-hospital length of stay following lung cancer surgery.

311 Background: Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, oncologists might resort to improvisational strategies, such as increasing the length of stay (LOS), a federal care quality measure with financial implication for hospitals, to better protect the health and safety of this medically vulnerable population. Methods: Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) Presidential Disaster Declaration in the county of the treatment facility between date of surgery and date of discharge from the hospital. Differences in the cumulative distribution function of LOS, defined as days between date of surgery and date of discharge from the hospital, were evaluated between exposed and propensity score matched unexposed patients, who were treated at the same facility but at a time when no disasters occurred, using the product-limit method and log-rank test. In sensitivity analysis, patients with discharge date equal to date of death (in-hospital mortality) were excluded, and the association was evaluated stratified by stage. Results: Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS (p<0.001) than unexposed patients (9.4days compared to 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment modality. In sensitivity analysis, there were no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively, p=0.76). Excluding patients who died in the hospital did not change the main results. Conclusions: Patients whose facility is impacted by a wildfire disaster during recovery from lung cancer surgery have longer length of stay than similar patients treated at the same facility but at times when no disaster occurred. Future studies should evaluate whether extended hospital stay improves safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient population.

Robot‐assisted radical prostatectomy in patient with previous intersphincteric resection for rectal cancer

IntroductionThere are often opportunities to consider treatment strategies for synchronous or metachronous prostate cancer with colorectal cancer. Performing robot‐assisted radical prostatectomy for prostate cancer following previous rectal cancer surgery in cases involving anal‐preserving surgeries such as low anterior resection or intersphincteric resection can be challenging because of the possibility of adhesions.Case presentationA 74‐year‐old man who had undergone laparoscopic intersphincteric resection for rectal cancer was diagnosed with prostate cancer. The patient desired to undergo robot‐assisted radical prostatectomy. During surgery, we observed the absence of Denonvillier's fascia on the dorsal surface of the prostate, the intestinal anastomosis was distal to the vesicourethral anastomosis, and the rectum was replaced with a peristaltic sigmoid colon with minimal adhesions.ConclusionPeriprostatic conditions vary depending on previous rectal surgical approaches. It is crucial to confirm the previous surgical approach for rectal cancer when performing robot‐assisted radical prostatectomy following rectal cancer surgery.

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

A propensity-matched cohort study of pre-operative immunonutrition in patient undergoing major gastrointestinal cancer surgery in Hong kong

A propensity-matched cohort study of pre-operative immunonutrition in patient undergoing major gastrointestinal cancer surgery in Hong kong

Long-term results using nutritional indicators in colorectal cancer surgery: Cachexia and modified glasgow prognostic score (MGPS)

Long-term results using nutritional indicators in colorectal cancer surgery: Cachexia and modified glasgow prognostic score (MGPS)

Functional outcomes of prehabilitation programme for sarcopenic patients undergoing major colorectal cancer surgery

Functional outcomes of prehabilitation programme for sarcopenic patients undergoing major colorectal cancer surgery

Prior Knowledge, Acceptance, Adaptation, and Challenges Following Stoma Formation among Colorectal Cancer Patients in Northern Peninsular of Malaysia: A Qualitative Study

INTRODUCTION: Stoma formation affects an individual in various ways, including physical, emotional, social, and cognitive functions. Diverse studies report ways of an individual lives with new stoma formation. However, the comprehensive understanding of the entire process by the patient, which includes knowledge before the surgical procedure, as well as the subsequent acceptance, adaptation, and challenges to living with a stoma is lacking. MATERIALS AND METHODS: In-depth interview session were conducted with 12 colorectal cancer patients who have undergone surgical procedures for intestinal stoma formation. The patterns and themes within the data were identified by thematic analysis, involving data familiarisation and coding followed by themes’ generation and refinement of the themes. RESULTS: Four themes and 9 subthemes were identified, which revealed the sufficiency of stoma-related information and understanding prior to surgery as well as positive acceptance of self and family members reflected through their reactions and support. Nonetheless, the challenges were anticipated which highlights the complications of the stoma itself, obstacles surrounding social life, and financial burdens. CONCLUSION: This study provided valuable insights into the experiences of individuals living with a stoma following colorectal cancer surgery. The themes and subthemes highlight the need to address social stigma as well as financial issues to alleviate the burden of stoma-related expenses. Increasing public awareness and improving financial assistance could be a way to enhance the overall quality of life for patients living with stoma

Evolution of overall survival (OS) after curative-intent lung cancer surgery in a population-based Mississippi Delta cohort.

278 Background: Surgical resection is the most important curative modality for patients with lung cancer, with long-term OS influenced by both surgical quality and cancer biology. We compared surgical care and outcomes over 4 eras in the population-based Mid-South Quality of Surgical Resection (MS-QSR) cohort, an ongoing regional surgical and pathologic quality improvement (QI) dissemination and implementation project. Methods: We implemented a surgical lymph node collection kit and a novel pathology gross dissection method across 12 hospitals encompassing >95% of lung cancer resections in 5 contiguous Dartmouth Hospital Referral Regions. We analyzed the MS-QSR cohort at 5-year intervals characterized by stepped-wedge implementation of specific QI interventions: Era 1 (2004-2008; baseline, no QI), Era 2 (2009-2013; quality feedback, surgical QI pilot), Era 3 (2014-2018; surgical QI implementation), and Era 4 (2019-2023; combined surgical QI and pathology QI implementation). We used standard statistical methods to compare surgical quality; Kaplan-Meier plot, log-rank test, and Cox proportional hazards model with Era 1 as reference to compare OS across eras. Results: Of 7240 resections, 14%, 31%, 29%, and 26% were performed in Eras 1-4, respectively (Table). Attainment of the stringent International Association for the Study of Lung Cancer (IASLC) definition of complete resection increased from 0% in Era 1 to 32% in Era 4; attainment of the American College of Surgeons Operative Standard 5.8 (ACS_OS 5.8), the current US definition of surgical quality, improved from 4% in Era 1 to 67% in Era 4; 120-day mortality rate decreased from 10% to 4% (p<0.0001 for all comparisons). With median follow-up of 4.7, 5.5, 5.6, and 2 years for Eras 1-4, 3-year OS rates were 60%, 64%, 70%, and 79%; 5-year OS rates were 48%, 52%, 58%, and 70%, respectively (p<0.0001). The Hazard Ratio (HR) for mortality decreased from 0.91 (95% CI: 0.8-0.99) in Era 2 to 0.49 (95% CI: 0.43-0.56) in Era 4. Conclusions: Surgical quality and OS sequentially improved in this diverse, high-risk population-based Mississippi Delta surgical resection cohort. We are evaluating the full range of factors associated with this striking OS improvement. Ongoing work is exploring biologic correlates to this improvement. Variable Era 1 N= 988 Era 2 N=2235 Era 3 N=2107 Era 4 N=1910 Median age (Q1, Q3) 68 (62, 74) 68 (62, 74) 68 (61, 74) 68 (61, 74) Male sex (%) 514 (52%) 1234 (55%) 1082 (51%) 977 (51%) Black race 221 (22%) 416 (19%) 450 (21%) 451 (24%) Attained ACS_OS 5.8 40 (4%) 533 (24%) 1050 (50%) 1272 (67%) IASLC complete resectionUncertain completeness 0 (0%)930 (94%) 194 (9%)1932 (86%) 435 (21%)1594 (76%) 606 (32%)1227 (64%) 120-day mortality 100 (10%) 197 (9%) 139 (7%) 72 (4%) 5-year OS 48 (45-51) 52 (50-55) 58 (56-60) 70 (66-74) HR (95% CI) Reference 0.91 (0.83-0.99) 0.75 (0.69-0.83) 0.49 (0.43-0.56)

The role of malnutrition assessment tools in estimating postoperative outcomes after upper gastrointestinal cancer surgery: A bi-center cohort study

The role of malnutrition assessment tools in estimating postoperative outcomes after upper gastrointestinal cancer surgery: A bi-center cohort study

Feasibility, clinical outcomes, and learning curves of robotic-assisted colorectal cancer surgery in a high-volume district general hospital: a cohort study

Introduction: Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH). Methods: A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times. Results: In the RAS cohort, the median age was 70 (IQR 57–78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, P=0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, P=0.10), as well as length of stay greater than 5 days (42% vs. 39%, P=0.27). For anterior resections performed by the highest volume surgeon (n=16), surgical time was reduced over 1 year by 35% (304.9–196.9 min), whilst console time increased by 111% (63.0–132.8 min). Conclusions: Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Impact of glim criteria defined malnutrition on short- and long-term clinical outcomes in patients after gastrointestinal cancer surgery

Impact of glim criteria defined malnutrition on short- and long-term clinical outcomes in patients after gastrointestinal cancer surgery

In Their Own Words: Patient Narratives of Breast Cancer Surgery and Reconstruction.

Breast cancer's global burden prompts a comprehensive understanding of patient experiences surrounding surgical interventions. Social media platforms serve as a new potential avenue for analysis, reflecting patients' coping mechanisms and support-seeking behaviors. This study's objective is to further understand patient experiences regarding breast cancer interventions via social media to improve physician-patient dialogue. A cross-sectional study was conducted of Instagram and TikTok posts surrounding breast cancer surgeries using procedure-related hashtags. Content was categorized to prevalent themes related to Breast-Q foci and was subsequently analyzed. Data from 1,028 individuals were analyzed. Posts encompassed double mastectomy (39%), single mastectomy (22%), and combineddeep inferior epigastric perforator flap, latissimus dorsi flap, and transverse rectus abdominis muscle flapreconstruction (39%). Frequently identified themes included 'Raising Awareness' (86.87%), 'Spreading Positivity' (53.11%), 'Resiliency' (31.03%), 'Online Support' (24.61%), 'Update of Appearance' (20.82%), 'Recovery/Rehab' (19.94%), and 'Scientific Explanation' (19.75%). Instagram posts more likely encompassed positivity (p < 0.001), resiliency (p = 0.001), and mental health (p = 0.011). TikTok posts more likely (p = 0.001) discussed scientific explanations, decision-making, and symptoms (p < 0.001). Preoperative posts more likely (p < 0.001) surrounded scientific explanations, decision-making, and fear. Postoperative posts more likely (p < 0.001) highlighted appearance updates, recovery/rehab, and positivity (p = 0.012). Experiences with mastectomy and reconstruction differed: recovery/rehab (p < 0.001), scientific explanations (p = 0.015), treatment process (p = 0.003), range of motion (p < 0.001), self-esteem (p = 0.017), and wound management (p = 0.008). Concerns of patients online reflect Breast-Q measures. Understanding these nuanced patient discussions can provide novel insights for providers. Tailoring interactions through these insights may facilitate enhanced support, discussions, and experiences throughout the treatment journey. Main Points Social media offers a unique insight into personal patient experiences Online breast surgery patient perspectives reflect Breast-Q measures Outlooks from shared online posts may facilitate physician-patient dialogue LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nutritional evaluation in cancer surgery pre-admission: A protocol for identifying patients in need of perioperative nutritional intervention

Nutritional evaluation in cancer surgery pre-admission: A protocol for identifying patients in need of perioperative nutritional intervention

Airway management for right thoracoscopic tracheal tumour resection after left pneumonectomy assisted by cardiopulmonary bypass: a case report

BackgroundThe incidence of secondary tracheal tumours following lung cancer surgery is notably low. Patients with tracheal tumours typically present with symptoms such as coughing, sputum production, haemoptysis, wheezing, stridor, and dyspnoea. In cases of peripheral structure invasion, symptoms may further extend to hoarseness and dysphagia. Initial symptoms may be notably non-distinct. However, the development of pronounced airway symptoms often signifies a critical condition.Case presentationA 70-year-old male with severe chest tightness and asthma was transferred to our hospital for emergency treatment. He had undergone left pneumonectomy for non-small cell carcinoma of the left upper lobe of the lung 3 years prior. The examination confirmed that a secondary tumour originated from the left main bronchus and extended to the carina, occupying 90% of the diameter of the tracheal lumen. To relieve the patient’s emergency airway, we chose right thoracoscopic resection of the tracheal tumour assisted by cardiopulmonary bypass (CPB), which provides extracorporeal lung support and a good surgical field.ConclusionIn patients with secondary tracheal tumours after left pneumonectomy for lung cancer, perioperative airway management is challenging for anaesthesiologists, and patients’ oxygenation should receive close attention. This article describes the airway management process of this patient for reference.